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Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts.
Nephrol Dial Transplant. 2010 Apr; 25(4):1173-83.ND

Abstract

BACKGROUND

Obesity is a risk factor for the progression of chronic kidney disease (CKD). The impact of weight loss on proteinuria and renal function is less clear. We aimed to determine the effect of intentional weight loss on proteinuria and kidney function.

METHODS

Three bibliographic databases including Medline, Cochrane and SCUPOS as well as reference list of articles were searched. We included randomized and non-randomized controlled trials as well as single-arm trials published in English through May 2009 which examined urinary protein among obese or overweight adults before and after weight loss interventions including dietary restriction, exercise, anti-obesity medications and bariatric surgery. Study characteristics and methodological quality of trials were assessed.

RESULTS

Five hundred twenty-two subjects from five controlled and eight uncontrolled trials were included. Weight loss interventions were associated with decreased proteinuria and microalbuminuria by 1.7 g [95% confidence interval (95% CI), 0.7 to 2.6 g] and 14 mg (95% CI, 11 to 17 mg), respectively (P < 0.05). Meta-regression showed that, independent of decline in mean arterial pressure, each 1 kg weight loss was associated with 110 mg (95% CI, 60 to 160 mg, P < 0.001) decrease in proteinuria and 1.1 mg (95% CI, 0.5 to 2.4 mg, P = 0.011) decrease in microalbuminuria, respectively. The decrease was observed across different designs and methods of weight loss. Only bariatric surgery resulted in a significant decrease in creatinine clearance.

CONCLUSIONS

Weight loss is associated with decreased proteinuria and microalbuminuria. There were no data evaluating the durability of this decrease or the effect of weight loss on CKD progression.

Authors+Show Affiliations

St. Joseph's Hospital, HealthEast Care System, University of Minnesota School of Public Health, Minneapolis, MN, USA. afshi001@umn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

19945950

Citation

Afshinnia, Farsad, et al. "Weight Loss and Proteinuria: Systematic Review of Clinical Trials and Comparative Cohorts." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 25, no. 4, 2010, pp. 1173-83.
Afshinnia F, Wilt TJ, Duval S, et al. Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrol Dial Transplant. 2010;25(4):1173-83.
Afshinnia, F., Wilt, T. J., Duval, S., Esmaeili, A., & Ibrahim, H. N. (2010). Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 25(4), 1173-83. https://doi.org/10.1093/ndt/gfp640
Afshinnia F, et al. Weight Loss and Proteinuria: Systematic Review of Clinical Trials and Comparative Cohorts. Nephrol Dial Transplant. 2010;25(4):1173-83. PubMed PMID: 19945950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. AU - Afshinnia,Farsad, AU - Wilt,Timothy J, AU - Duval,Sue, AU - Esmaeili,Abbas, AU - Ibrahim,Hassan N, Y1 - 2009/11/27/ PY - 2009/12/1/entrez PY - 2009/12/1/pubmed PY - 2010/8/18/medline SP - 1173 EP - 83 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 25 IS - 4 N2 - BACKGROUND: Obesity is a risk factor for the progression of chronic kidney disease (CKD). The impact of weight loss on proteinuria and renal function is less clear. We aimed to determine the effect of intentional weight loss on proteinuria and kidney function. METHODS: Three bibliographic databases including Medline, Cochrane and SCUPOS as well as reference list of articles were searched. We included randomized and non-randomized controlled trials as well as single-arm trials published in English through May 2009 which examined urinary protein among obese or overweight adults before and after weight loss interventions including dietary restriction, exercise, anti-obesity medications and bariatric surgery. Study characteristics and methodological quality of trials were assessed. RESULTS: Five hundred twenty-two subjects from five controlled and eight uncontrolled trials were included. Weight loss interventions were associated with decreased proteinuria and microalbuminuria by 1.7 g [95% confidence interval (95% CI), 0.7 to 2.6 g] and 14 mg (95% CI, 11 to 17 mg), respectively (P < 0.05). Meta-regression showed that, independent of decline in mean arterial pressure, each 1 kg weight loss was associated with 110 mg (95% CI, 60 to 160 mg, P < 0.001) decrease in proteinuria and 1.1 mg (95% CI, 0.5 to 2.4 mg, P = 0.011) decrease in microalbuminuria, respectively. The decrease was observed across different designs and methods of weight loss. Only bariatric surgery resulted in a significant decrease in creatinine clearance. CONCLUSIONS: Weight loss is associated with decreased proteinuria and microalbuminuria. There were no data evaluating the durability of this decrease or the effect of weight loss on CKD progression. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/19945950/Weight_loss_and_proteinuria:_systematic_review_of_clinical_trials_and_comparative_cohorts_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfp640 DB - PRIME DP - Unbound Medicine ER -